Progression of ganglionic germinal matrix bleed to intraparenchymal hemorrhages
Prognosis of neonates with ganglionic germinal matrix hemorrhages
prognosis of neonates with germinal matrix hemorrhage depends on
its evolution. Germinal matrix hemorrhage without any progression
has a good prognosis. The prognosis of germinal matrix hemorrhages
that progress to intraventricular hemorrhages depends on its subsequent
evolution. Neonates whose intraventricular hemorrhages resolve have
a better prognosis that those neonates with intraventricular hemorrhages
that produce hydrocephalus.
site of an intra-axial hematoma in the fullterm neonate differs from
that of the premature neonate. Intra-axial hematomas in the fullterm
neonate may occur in the periventricular area, centrum semiovale,
thalamus, or ventricles.
CEREBELLAR, BRAINSTEM, AND SPINAL CORD HEMORRHAGES
Cerebellar, brainstem, and spinal cord hemorrhages are very rare in the neonatal period. Cerebellar hemorrhages may occur as a result of arteriovenous malformation rupture, venous infarction, cerebellar contusion, or due to extension of an intraventricular or subarachnoid hemorrhage. Cerebellar hemorrhages are more common in premature infants than in fullterm infants. The possibility of a bleeding diathesis, a posterior fossa skull fracture, or von Hippel-Lindau disease should be considered in a neonate with cerebellar hematomas. von Hippel-Lindau disease is characterized by retinal angiomas; cerebellar and spinal cord spinal cord hemangioblastomas; renal cell carcinomas; pheochromocytomas; angiomas of the liver and kidney; and cysts of the pancreas, kidney, liver and epididymis. von Hippel-Lindau is a an autosomal dominant disorder due to a defective tumor supressor gene at chromosome 3p25-26.Most neonates with cerebellar hematomas require observation only (Figure 256.2). Surgical treatment is restricted to large surface cerebellar hematomas with mass effect.
Figure 256.2.— Cerebellar hematoma. [A] T1-coronal view demonstrates a large circular lesion with peripherally increased signal in the right cerebellar hemisphere. [B] T2-coronal view demonstrates a large circular lesion devoid of signal.
Spinal cord hemorrhages are usually due to trauma. Bleeding diathesis and arteriovenous malformations are infrequent causes of intraparenchymal spinal cord bleeding (Figure 256.4).